Incidence Of Spinal Cord Injury Research Articles

Healthcare Service Utilization and Related Costs. A Comparison of the Situation of Persons With Spinal Cord Injury to the General Population.

The aim of the study is to investigate healthcare utilization and related costs in spinal cord injury compared to the Swiss population, addressing gaps in understanding this vulnerable group's needs. We analyzed healthcare utilization across age groups using data from the Swiss Health Survey and the Swiss Community Survey. Employing count models, Zero-Inflated Negative Binomial, and Poisson regressions, we estimated the adjusted healthcare visits across different age groups in the sample. Persons with spinal cord injury use 11 times more healthcare services than the healthy population and 4 times more than persons with other chronic health conditions. Notably, service providers for persons with spinal cord injury include physiotherapists, nursing services, general practitioners, and specialists. The high frequency of usage of persons with spinal cord injury translates into high costs, which is 3 times higher than in the general healthy population. These patterns become more evident as persons with spinal cord injury age, where nursing care and rehabilitation services become the most demanded services. Our findings show the multiple healthcare needs of people with spinal cord injury, which makes them a high-needs, high-cost group. This characteristic underscores the importance of preventive measures to reduce the incidence of spinal cord injury in older adults.

Safety and validity of selective cerebrospinal fluid drainage in open and endovascular aortic repair.

Although cerebrospinal fluid drainage has been shown to reduce the risk of ischemic spinal cord injury, serious complications have also been reported. We have been using it selectively in a pressure- and volume-regulated method and aimed to evaluate its safety, and its validity in elective thoracic endovascular aortic repair in a propensity-matched cohort. Among the 450 patients who underwent open surgery (n = 169) or thoracic endovascular aortic repair (n = 281) on the descending or thoracoabdominal aorta, 147 underwent cerebrospinal fluid drainage, which was prophylactic in 135 and therapeutic in 12. Prophylactic drainage was performed in elective open surgery under distal aortic perfusion (n = 67) or in selected patients undergoing thoracic endovascular aortic repair (n = 68). Drainage-related complications were observed in 13 (9.6%), one of which was graded severe (0.74%). In patients undergoing prophylactic drainage, spinal cord injury was detected in 2/135 (1.5%). In patients without prophylactic drainage, 15/315 (4.8%) developed spinal cord injury. Therapeutic drainage was performed in 12 of these 15 patients, 10 of whom remained paralytic in varying degree. In the inverse probability weighted analysis of the patients undergoing elective thoracic endovascular aortic repair, the incidence of spinal cord injury was lower with prophylactic drainage (p = 0.028). Pressure- and volume-regulated spinal drainage rarely causes serious complications. Its prophylactic use seems beneficial in selected patients, including those undergoing thoracic endovascular aortic repair with high risk for spinal cord injury.

Community-Based Exercise Programs Post Spinal Cord Injury Hospitalization: A Pilot Study for a Randomized, Multicenter, Double-Blind Controlled Setting.

This study explores the effectiveness of community-based exercise programs for individuals with spinal cord injury (SCI) following hospital discharge. Given the rising incidence of SCI, particularly in South Korea, and the associated long-term disabilities, the necessity for comprehensive post-discharge rehabilitation is paramount. The study focuses on a pilot randomized multicenter double-blind controlled trial, targeting SCI patients who have completed inpatient rehabilitation and are living in the community. The primary aim is to evaluate the impact of structured exercise programs on physical fitness, functional capacity, and overall recovery. The research introduces the SpinalFit program, a community-based intervention designed to enhance muscle strength, cardiopulmonary endurance, and mobility through a combination of aerobic and resistance training. This program addresses the critical need for safe and effective rehabilitation options outside the hospital setting, utilizing circuit training with resistance bands and body-weight exercises tailored to each participant's capacity. The study also investigates barriers to physical activity in the community for SCI patients and the potential role of community exercise centers in bridging this gap. Preliminary findings from this pilot trial are expected to provide valuable insights into optimizing exercise regimens for SCI patients, informing future large-scale studies and contributing to improved post-discharge rehabilitation strategies.

The effect of ATLS/PHTLS spinal motion restriction protocol on the incidence of spinal cord injury, a nationwide database study

PurposeTo study trends in incidence and outcome of patients with traumatic spinal cord injury (TSCI) in the Netherlands before, during and after implementation of the Advanced Trauma Life Support (ATLS®) and Pre-Hospital Trauma Life Support (PHTLS®)- Spinal Motion Restriction(SMR) protocol.MethodsIn an observational database we studied national hospital admission and emergency department databases to analyse incidence rates and outcome of traumatic spinal cord injury and spinal fractures in the emergency department and in admittances in The Netherlands between 1986 and 2021.ResultsA significant increase of 39% in TSCI in admitted patients with spinal fractures over the past 35 years (p < 0.001). This increase was especially prevalent in cervical spinal fractures (132%), while thoracic and lumbosacral spinal fractures showed a decrease in accompanied TSCI (64% and 88% respectively). The overall increase in spinal fractures was not significant. The duration of hospital admission decreased for spinal fractures without TSCI and with TSCI (66% and 56% respectively).ConclusionSince implementation of the SMR-protocol was aiming to limit TSCI in patients who suffered a spinal fracture, the increase in TSCI is an unexpected finding. Exact explanation for this increase is unclear and the contribution of the SMR-protocol is not fully understood due to confounders in the used datasets. Either way, the scientific evidence supporting this costly time- and labor-intensive SMR-protocol remains debated, along with evidence contradicting it. Therefore it stresses the need for clear, evidencebased reasoning for spinal immobilization according to ATLS, as this is currently lacking.

Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair

ObjectiveDuring open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we used a routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004 to June 2009 and after 2017, we used a selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009 to 2016. This study reviewed our nearly 2-decade experience to assess the impact of 2 ICA reattachment strategies on spinal cord injury (SCI). MethodsAll open DTAA/TAAA repairs performed from July 2004 to June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage. Perioperative data were reviewed. Univariable and multivariable analyses and propensity matching for risk-adjusted effects of 2 strategies for ICA reattachment on SCI were used. ResultsIn all, 375 patients were operated on with selective strategy and 584 with routine strategy. Age and prevalence of rupture and redo were similar in the 2 groups. The rate of operative mortality and immediate SCI was also similar (selective vs routine: mortality, 12.5% vs 12.3%; immediate SCI, 3.2% vs 2.2%). However, the incidence of delayed and permanent SCI was increased in the selective group (delayed, 10.4% vs 6.9%; permanent, 8.5% vs 5.3%). Multivariable analyses demonstrated selective strategy was a predictor of delayed and permanent SCI, along with TAAA extent II/III, and older age. ConclusionsTwo strategies of ICA reattachment did not impact the incidence of immediate SCI, which was infrequent, but the selective strategy was associated with greater rates of delayed permanent SCI. Reattachment of the ICAs within T8-T12 should be performed during open DTAA/TAAA.

Global incidence and characteristics of spinal cord injury since 2000–2021: a systematic review and meta-analysis

BackgroundThis study employs systematic review and meta-analysis to explore the incidence and characteristics of spinal cord injury (SCI) between 2000 and 2021, aiming to provide the most recent and comprehensive data support for the prevention, diagnosis, treatment, and care of SCI.MethodsSystematic searches were conducted on epidemiological studies of SCI published between January 1, 2000, and March 29, 2024. Meta-analysis, subgroup analysis, meta-regression, publication bias detection, and literature quality assessment were extensively utilized.ResultsThe pooled results from 229 studies indicated that the overall incidence rate of SCI was 23.77 (95% CI, 21.50–26.15) per million people, with traumatic spinal cord injuries (TSCI) at a rate of 26.48 (95% CI, 24.15–28.93) per million people, and non-traumatic spinal cord injuries (NTSCI) at a rate of 17.93 (95% CI, 13.30-23.26) per million people. The incidence of TSCI exhibited a marked age-related increase and was significantly higher in community settings compared to hospital and database sources. Males experienced TSCI at a rate 3.2 times higher than females. Between 2000 and 2021, the incidence of TSCI remained consistently high, between 20 and 45 per million people, whereas NTSCI incidence has seen a steady rise since 2007, stabilizing at a high rate of 25–35 per million people. Additionally, the incidence of TSCI in developing countries was notably higher than that in developed countries. There were significant differences in the causes of injury, severity, injury segments, gender, and age distribution among the TSCI and NTSCI populations, but the proportion of male patients was much higher than that of female patients. Moreover, study quality, country type, and SCI type contributed to the heterogeneity in the meta-analysis.ConclusionsThe incidence rates of different types of SCI remain high, and the demographic distribution of SCI patients is changing, indicating a serious disease burden on healthcare systems and affected populations. These findings underscore the necessity of adopting targeted preventive, therapeutic, and rehabilitative measures based on the incidence and characteristics of SCI.

Stem Cell Therapies for Spinal Cord Injury - A Review

The escalating incidence of Spinal Cord Injury (SCI), with approximately 0.9 million cases globally, underscores its growing public health concern. Traumatic SCI, often prevalent in developing nations due to factors like motor vehicle accidents and falls, leads to secondary damage involving inflammation, neuronal death, and ionic dysregulation. Despite the absence of an effective treatment for SCI, Stem Cell Therapy (SCT) emerges as a promising avenue, harnessing stem cells' unique capabilities for regeneration and replacement. The review explores various stem cell types, such as Neural Stem/Progenitor Cells (NS/PCs), Embryonic Stem Cells (ESCs), Induced Pluripotent Stem Cells (iPSCs), and Mesenchymal Stem Cells (MSCs), detailing their potential in preclinical and clinical contexts. Specifically, NSCs exhibit therapeutic promise by modulating astrocyte contribution, enhancing differentiation, and promoting growth factors. ESCs, despite their pluripotency, face ethical concerns and potential teratocarcinoma formation. IPSCs, reprogrammed from somatic cells, showcase potential in treating SCI without ethical issues. MSCs, with diverse sources like bone marrow, umbilical cord, and adipose tissue, offer versatility in differentiation and therapeutic benefits. Clinical trials with MSCs, especially BM-MSCs, UC-MSCs, and AD-MSCs, demonstrate improvements in motor and sensory functions, highlighting their regenerative potential. Despite promising results, challenges such as potential tumorigenesis and high costs persist, warranting further exploration and clinical translation of these stem cell therapies for SCI.

CERVICAL DEGENERATIVE MYELOPATHY, PANORAMIC REVIEW

Introduction: cervical degenerative myelopathy (DCM) is a general term that entails multiple etiologies. DCM is a group of pathological entities that originate compression of the cervical spinal cord, where spasticity, hyperreflexia, pathological reflexes, loss of manual dexterity, among others, are found. Objective: to detail the current information related to cervical degenerative myelopathy, epidemiology, clinical presentation, role of complementary examinations, pathophysiology, pathogenesis and treatment. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: cervical degenerative myelopathy, cervical spondylotic myelopathy, cervical pain, ossification of the yellow ligament and degenerative disc disease. Results: cervical myelopathy occurs in almost all individuals with canal stenosis greater than 60%. Spinal cord injury (SCI) is a devastating disorder that influences remarkable neurological morbidity and significant wear and tear on quality of life. The incidence and prevalence of SCI in North America is between 4.1 and 60.5 per 100,000, robust epidemiological data is difficult to obtain because of the multifactorial etiology of the disease process. Conclusions: cervical degenerative myelopathy involves multiple etiologies, all these entities together represent the most common reason for degenerative and non-traumatic alteration of the spinal cord in adult individuals. Degenerative disorders are more common at C5 and C6 or C6 and C7, because of the increased mobility in these sections. It is difficult to obtain solid epidemiological data because of the multifactorial etiology of the disease process. The symptoms and signs presented by the pathology are varied, so an adequate physical examination and a good clinical history should be taken. The pathology can significantly alter neurological function and lead to disability, so early recognition and treatment can prevent further deterioration of affected individuals. Surgical decompression is almost universally indicated with the intention of preventing progression and achieving maximum recovery potential. KEY WORDS: myelopathy, cervical, degenerative, pain, spinal, neuralgia.

Causes of Traumatic Spinal Cord Injury with Gender Distribution and Most Commonly Affected Age Group

Background: Spinal cord injury (SCI) has significant consequences, especially for young adults, requiring comprehensive support. Additionally, non-traumatic SCI is under-researched in Pakistan, highlighting the need for further investigation. Managing readmissions post-discharge remains a global challenge for SCI patients. This study conducted at Paraplegic Centre Peshawar aims to find the traumatic causes of spinal cord injury with gender and age distribution. Methods: A retrospective study was conducted at Paraplegic Center in Hayatabad and Prime Teaching Hospital, Peshawar. Over two months, 1843 patients were recruited from hospital records with permission from the department head. Data collection forms were designed to include age, gender, and cause of SCI, ensuring confidentiality by excluding personal identifiers. SPSS-V19 was used for data analysis. Results: Our study included 1843 patient records, with males comprising 80.7% and females 19.3%. Among different age groups, individuals aged 30 and older represented the highest proportion at 52.7%. The primary causes of spinal cord injury were falls from height (46.3%) and firearm injuries (25.9%). Paraplegic injuries were more prevalent, accounting for 87.9% of cases compared to quadriplegic injuries at 12.1%. These findings shed light on the demographics and patterns of spinal cord injuries, providing valuable insights for healthcare management and prevention strategies. Conclusion: Falls are major cause of spinal cord injury (SCI). Mean age patients suffers are 26. frequency of SCI is more in males then females. Paraplegia is more common then quadriplegia. The socioeconomic impact of SCI is eminence because it is affecting the youth population. It is important to understand the epidemiological features of SCIs which could lead to plan appropriate cost-effective prevention strategy in order to reduce the SCI prevalence and incidence in our community.

Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border.

This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p < 0.00330). Patients with a spine fracture fell from a higher median fall height (6.1 vs. 4.6 m; p < 0.001), which resulted in longer median length of stay (LOS; 12 vs. 7 days; p < 0.001), greater median Injury Severity Score (ISS; 20 vs. 9; p < 0.001), and greater relative risk (RR) of ISS >15 (RR = 3.2; p < 0.001). Patients with operative spine injuries had significantly longer median intensive care unit (ICU) LOS than patients with non-operative spine injuries (4 vs. 2 days; p < 0.001). Patients with spinal cord injuries and ISS >15 sustained falls from a higher distance (median 6.1 vs. 5.5 m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p < 0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR = 3.5; p 0.0353) and chest injuries (RR = 6.0; p = 0.0238), but a lower incidence of lower extremity injuries (RR = 0.5; p < 0.001). Thoracolumbar injuries occurred in 68.4% of all patients with spine injuries. Patients with operative spine injuries had a higher incidence of burst fracture (RR = 15.5; p < 0.001) and flexion-distraction injury (RR = 25.7; p = 0.0257). All patients with non-operative spine injuries had American Spinal Injury Association (ASIA) D or E presentations, and patients with operative spine injuries had a higher incidence of spinal cord injury: ASIA D or lower at time of presentation (RR = 6.3; p < 0.001). Falls from walls in border crossings result in significant injuries to the head, spine, long bones, and body, resulting in polytrauma casualties. Falls from higher height were associated with a higher frequency and severity of spinal injuries, greater ISS, and longer ICU length of stay. Operative spine injuries, compared with non-operative spine injuries, had longer ICU length of stay, greater ISS, and different fracture morphology. Spine surgeons and neurocritical care teams should be prepared to care for injuries associated with falls from height in this unique population.

Explaining the challenges of Iranian caregivers in provision of home health care to spinal cord injury patients: a qualitative study

BackgroundThe incidence of spinal cord injury (SCI) is increasing across the globe. The caregivers of patients with spinal cord injuries experience many problems during providing care to these patients. Identifying the problems experienced by caregivers can facilitate the process of care provision to these patients. So, the aim of this study was to explore the challenges of caregivers in provision of home health care to SCI patients.MethodsThis study was conducted by qualitative description approach in Iran from Apr 2021 to Dec 2022. The participants included the caregivers of SCI patients recruited by purposive sampling. The data were collected by face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim.ResultsTwo themes emerged from the data analysis, including burnout (with the categories of physical challenge and psychological challenges) and coping strategies (with the categories of social support and professional support).ConclusionResolving the obstacles and problems faced by home caregivers can improve the circumstances of care provision so that they can be relieved of their own physical and psychological conundrums and deliver suitable home care to SCI patients.Trial registration numberNot applicable.

Epidemiology of spinal cord injury and spinal cord injury–induced urinary tract stones in Taiwan: A 2005–2015 population-based cohort study

Context Patients with spinal cord injury (SCI) can develop urinary tract stones (UTSs) up to years after the injury, which is especially common in the first few months. However, relevant epidemiological studies and up-to-date epidemiological data for SCI in Taiwan are lacking. Purpose To estimate SCI and SCI-induced UTS incidence and trauma severity, neurological deficits, and injury site in patients with SCI-induced UTSs in Taiwan. Design Retrospective cohort study. Patient sample: Taiwan National Health Insurance Research Database (NHIRD) data and death data from the Department of Health and Welfare Data Science Center (HWDC) collected over 2005–2015 from 13,977 patients with SCI aged >18 years. Outcome measures Cumulative incidence (CI), incidence density (ID), relative ratios (RRs), odds ratios (ORs), and hazard ratios (HRs) were measured. Methods By using Cox regression, we assessed UTS risk in patients with SCI. Results Although standardized SCI incidence demonstrated a decreasing trend annually, the average annual incidence remained at 60.4 per million. Most (65.7%) of the included patients were men. SCI incidence was 1.98 times higher in men than in women. The most common injury site was the cervical spine (63.8%); the incidence at this site was 2.83 times higher in men than in women. Most (76.1%) of the patients had traumatic SCI (TSCI), and the standardized incidence of TSCI and non-TSCI was 45.9 and 14.4 per million, respectively. 46.1% of the patients had severe SCI (RISS ≥ 16). Over the 11-year follow-up period, UTSs occurred in 10.4% of the patients, with a standardized incidence of 2.39 per 100 person-years, and UTS risk was 1.56 times higher in men than in women. Age of 45–65 years, SCIs at multiple sites, and neurological deficits (e.g. paraplegia) were noted to be UTS risk factors. Finally, UTS onset mainly occurred in the first year after SCI. Conclusion The risk of UTS among patients with SCI is influenced by age, sex, injury site, and paraplegia but not by paralysis resulting from other neurological deficits. Even though SCI incidence is declining annually, severe SCI remains a significant issue. Therefore, continuing to reduce SCI incidence and strengthening urinary tract management in patients with SCI are essential for reducing UTS occurrence and their impact on health.

Spinal Cord Injury Risk in Open Repair for Descending Thoracic and Thoracoabdominal Aneurysm.

Objective: In open repair for descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA), the influence of re-interventions on spinal cord injury (SCI) remains unclear. This study evaluated the relationships between re-interventions, atherosclerosis, and SCI. Methods: We retrospectively reviewed 78 patients who underwent open surgical repair for DTAA or TAAA between April 2011 and May 2023. The associations of SCI with (i) re-interventions with a history of endovascular therapy and graft replacement and (ii) atherosclerotic factors, including monocyte count, triglyceride levels (TG), and intra-aortic plaques, were examined. Results: The rates of SCI complications and 30-day mortality were both 3.8% (3/78). There was no significant difference between the incidence of SCI in the re-intervention and first-time intervention groups (p >0.90). However, patients with protruding plaque on computed tomography (CT) were more affected by SCI than those without (13.3% vs. 1.6%, p = 0.034). Univariate analysis revealed that SCI was associated with increased monocyte count, TG, protruding plaques on CT, and intraoperative blood loss. Conclusion: Re-interventions for DTAA and TAAA showed no association with the development of SCI under appropriate protective measures. The implicated risk factors may be atherosclerosis factors such as elevated monocyte count, TG, and protruding plaques on CT.

Neurogenic Bowel Management in Traumatic Spinal Cord Injury – A Narrative Review

Abstract Neurogenic bowel management in persons with spinal cord injury (SCI) is an important issue due to the associated morbidities causing a significant impact on the persons’ quality of life (QOL) and burden the caregiver and healthcare services. Complications such as constipation, diarrhoea, incontinence, social embarrassment and autonomic dysreflexia can be managed effectively and resourcefully to counter the ill effects. In India, the incidence of SCI is 15,000, with a prevalence of 0.15 million; most are educationally and economically underprivileged with substandard living conditions. Complications associated with neurogenic bowel tend to impede the implementation of vocational rehabilitation and community integration measures. The goals of management are to prevent complications and improve the QOL of persons with SCI. With the revolutionary progress in medical science, many pharmacological, non-pharmacological and surgical options have been formulated to satisfactorily and effectively manage the neurogenic bowel. In this narrative review, we have tried to compile some of the most popular and time-tested options for managing neurogenic bowel in persons with SCI.

Current strategies for regenerative therapy of spinal cord injury

Spinal cord injury (SCI) is a leading cause of death and severe disability amongst young people. The incidence of SCI is 0.6–1.0 per 10,000 individuals. Unfortunately, there are no effective methods of restoring locomotor function for individuals with severe SCI. To address this issue, exoskeleton technology controlled using BCI is actively being developed for prosthetic locomotion. Despite the lack of encouraging data for severe spinal cord injuries, regenerative technologies continue to hold promise for spinal cord repair. The limited options for regenerating the central nervous system in humans necessitate creating new sources of neural stem cells for regeneration. Reprogramming autologous somatic cells neurologically can effectively serve as such a source [1]. Nevertheless, the constitution of neuroglial progenitors, which are necessary for regenerating damaged axons of the pyramidal tract, still requires clarification [2]. Some interesting efforts are underway to directly reprogram glial cells in situ using a variety of biotechnological approaches [3]. Overcoming or preventing the formation of a harsh scar tissue at the injury site is the key obstacle to successful regeneration therapy for SCI. Various scaffolds are being developed to facilitate axon regeneration, and several gene therapy agents are being tested to either knock down scar formation factors or activate extracellular matrix remodeling and reparative regeneration. Neuromodulation shows promise for SCI treatment. Studies indicate that epidural stimulation of the L2-S1 spinal cord in humans and mammals activates SPG neurons, aiding spinal walking generator functions. A potentially successful treatment approach involves scaffolds with reprogrammed cells and neuromodulation [4].

An Insight into the Prospects and Drawbacks of Stem Cell Therapy for Spinal Cord Injuries: Ongoing Trials and Future Directions.

Spinal cord injury (SCI) is a devastating neurological disorder that has a substantial detrimental impact on a person's quality of life. The estimated global incidence of SCI is 40 to 80 cases per million people and around 90% of cases are traumatic. Various etiologies can be recognized for SCI, and post-traumatic SCI represents the most common of these. Patients worldwide with SCI suffer from a persistent loss of motor and sensory function, which affects every aspect of their personal and social lives. Given the lack of effective treatments, many efforts have been made to seek a cure for this condition. In recent years, thanks to their ability to regenerate tissue and repair lost or damaged cells, much attention has been directed toward the use of stem cells (embryonic, induced pluripotent, mesenchymal, hematopoietic), aimed at restoring the functional integrity of the damaged spinal cord and improving a functional recovery including sensory and motor function. In this paper, we offer an overview of the benefits and drawbacks of stem cell therapy for SCI based on clinical evidence. This report also addresses the characteristics of various stem cell treatments, as well as the field's likely future. Each cell type targets specific pathological characteristics associated with SCI and demonstrates therapeutic effects via cell replacement, nutritional support, scaffolds, and immunomodulation pathways. SCI accompanied by complex pathological processes cannot be resolved by single treatment measures. Stem cells are associated with the adjustment of the expression of neurotrophic factors that help to achieve better nutrition to damaged tissue. Single-cell treatments have been shown in some studies to provide very minor benefits for SCI in multiple preclinical studies and a growing number of clinical trials. However, SCI damage is complex, and many studies are increasingly recognizing a combination approach such as physical therapy, electrical stimulation, or medication therapy to treatment.

Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis.

Spinal cord injuries, often resulting from spine fractures, can lead to severe lifelong symptoms such as paraplegia and even mortality. Over the past few decades, there has been a concerning increase in the annual incidence and mortality rates of spinal cord injuries, which has also placed a growing financial strain on healthcare systems. This review aims to offer a comprehensive overview of spinal cord injuries by estimating their global incidence, prevalence, and the impact in terms of years lived with disability, using data obtained from the 2019 Global Burden of Disease Study. In this study, we utilized data from the 2019 Global Burden of Disease Study, a widely recognized source for global health data. Our methodology involved estimating the global incidence and prevalence of spinal cord injuries while also assessing the impact on years lived with a disability. We analyzed this data comprehensively to identify patterns and trends and made predictions. This research delved into the evolving trends in the global burden of spinal cord injuries, identified key risk factors, and examined variations in incidence and disability across different Socio-demographic Index (SDI) levels and age groups. Briefly, in 2019, the global incidence and burden of YLDs of SCI significantly increased compared to 1990. While males had higher incidence rates compared to females. Falls were identified as the primary cause of SCI. Trend projections up to 2030 revealed a slight decrease in ASIR for males, an upward trend in age-specific incidence rates for both sexes and a similar pattern in age-standardized YLD rates. Additionally, our findings provided crucial groundwork for shaping future policies and healthcare initiatives, with the goal of mitigating the burden of spinal cord injuries, enhancing patient outcomes, and fortifying prevention efforts. Understanding the global burden of spinal cord injuries is essential for designing effective healthcare policies and prevention strategies. With the alarming increase in prevalence rates and their significant impact on individuals and healthcare systems, this research contributes vital insights to guide future efforts in reducing the incidence of spinal cord injuries, improving the quality of life for affected individuals, and reducing the economic burden on healthcare systems worldwide.

Prehospital Emergency Interventions for Idiopathic Spinal Cord Injury Prevention

Introduction: Despite the critical role of prehospital management, variations persist in global practices. Recent literature indicates that about 35% of emergency medical services (EMS) providers adhere to established guidelines for spinal immobilization in certain regions. This systematic review aimed to contribute to the ongoing dialogue surrounding the prehospital management of SCIs, ultimately improving outcomes for individuals affected by these traumatic injuries. Methods: A comprehensive literature review was conducted through a systematic search of electronic databases, employing refined search terms and Boolean operators to focus on prehospital management of spinal cord injuries from the inception of each database to July 2023. Inclusion criteria involved original research articles, systematic reviews, and meta-analyses, with a screening process led by two independent reviewers and subsequent data extraction to inform evidence synthesis, accounting for study limitations and bias assessments. Results: This systematic review summarizes findings from eight clinical interventional studies on preventing idiopathic spinal cord injury (SCI) during prehospital emergency aid for traumatized patients. The studies encompassed diverse populations and interventions, revealing variable effectiveness in reducing idiopathic SCI incidence. Notably, specialized protocols for pediatric spinal immobilization and modifications for geriatric patients demonstrated promising effectiveness, emphasizing the importance of age-specific considerations in prehospital care for SCI prevention. Conclusions: The systematic review findings underscore the nuanced nature of prehospital interventions for idiopathic spinal cord injury prevention, emphasizing the importance of age-specific considerations and cautioning against a one-size-fits-all approach, while also highlighting the need for ongoing research to refine protocols and improve patient outcomes given the lack of definitive evidence in favor of early versus delayed immobilization.

Abstract 18173: Spinal Cord Protective Strategy Before Extensive Surgical Procedure for Patients With Acute Type A Aortic Dissection

Introduction: Spinal cord injury (SCI) is a devastating complication following total arch replacement (TAR) with frozen elephant trunk (FET) procedure in acute type A aortic dissection (ATAAD). This study aims to evaluate the efficacy of spinal cord protective strategy (SCPS) implemented before this extensive procedure. Methods: Between January 2013 and December 2021, a total of 1105 ATAAD patients underwent TAR with FET procedure. SCPS included preoperative assessment of segment number of the false lumen closest to the spinal cord between T9-L3 level. If segment number exceeded 5, indicating high risk of postoperative SCI, prophylactic cerebrospinal fluid drainage would be conducted. SCPS was performed since June 2017 at our institution (703 patients). The remaining 402 patients were served as the control group. The two groups were compared to assess the efficacy of SCPS in preventing SCI. Results: The average age was significantly higher in the SCPS group (48.9±11.1 vs 46.6±10.0, P&lt;0.001). The patients in SCPS group presented with higher percentage of coma (P&lt;0.001). The mean duration of cardiopulmonary bypass was significantly longer in SCPS group (P&lt;0.001), while the mean duration of hypothetical cardiac arrest was significantly lower (P&lt;0.001). Propensity score matching was conducted, resulting in a matched sample of 186 patients from each group to adjust for differences in patient characteristics. The incidence of postoperative SCI was significantly lower in SCPS group (1.7% vs 7.2%, P&lt;0.001). Propensity score matching demonstrated higher estimated incremental protective efficacy of SCPS (1.1% vs 9.7%, P&lt;0.001). Multivariate logistic regression analysis revealed that preoperative SCPS was an independent protective factor for postoperative SCI (OR=0.226, 95% CI: 0.114-0.448, P&lt;0.001). Conclusions: The implementation of preoperative SCPS is an effective strategy for reducing the incidence of SCI follow extensive surgical procedure in ATAAD.

The impact of COVID-19 and associated lockdowns on traumatic spinal cord injury incidence: a population based study

Study designNatural experimentObjectivesTo determine whether COVID-19 restrictions were associated with changes in the incidence of traumatic spinal cord injury (TSCI) in Scotland.SettingThe Queen Elizabeth National Spinal Injuries Unit (QENSIU), the sole provider of treatment for TSCI in Scotland.MethodsTime series analysis of all admissions for TSCI between 1st January 2015 and 31st August 2022.ResultsOver the 8-year study period, 745 patients were admitted to the QENSIU with a TSCI. Interrupted time series analysis showed that level 3 and 4 COVID-19 lockdown restrictions (the most severe levels) were associated with lower incidence of TSCI (RR 0.63, CI% CI 0.47, 0.82, p < 0.001). The associations were stronger in people aged over 45 (additive interaction p = 0.001), males (additive interaction p = 0.01) and non-tetraplegia (additive interaction p = 0.002). The incidence of TSCI due to deliberate self-harm was higher (0.41 versus 0.23 per month) during restrictions.ConclusionsOverall, TSCI incidence reduced in Scotland when lockdowns were implemented, presumably due to lower engagement in risky activities. The increase in TSCI due to deliberate self-harm may reflect increased mental health problems and social isolation and should be anticipated and targeted in future pandemics. The change in incidence during the COVID-19 pandemic may have an economic impact and see a temporary reduction in the burden on health and social care. The results of this study will be useful for resource planning in future pandemics.